Diseases of the Breast

Other lesions

a. Duct ectasia
b. Enzymatic fat necrosis

I. Review of Normal Anatomy/Histology

- The mammary tissue/breast is a modified sweat gland.

- Sweat gland – the histologic structures has 2 components: secretory compartment and
excretory compartment.
- Secretory portion / acini– responsible for secretion of the product—milk. Once needed,
it will thrown out to the duct by the help of myothelial cells will contract and go out and
go to parts where milk is needed.
- Modified sweat glands Because it has lobules and acini.

Histology

“Rule of 2”

2 Main structures: Terminal Duct lobular unit and Large ducts

2 Types of Epithelial cells: luminal cells and myoepithelial cells

2 types of stroma: Interlobular and intralobular

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2 Main Structures:

1. TDLU / AKA Lobule

- Alveoli and ductile
- Intralobular terminal duct
- Extralobular terminal duct
- Intralobular stroma
- Lobule

Once there is secretion it will go into SUBSEGMENTAL DUCT > SEGMENTAL DUCT > LACTIFEROUS SINUS
> COLLECTING DUCT > NIPPLE.

- TDLU is made up of different acini called Alveoli. Use acini or acinus / ductules to not
confuse with the alveoli of the lungs; made up of duct.
- Considered as Morphofunctional unit of breast
- Lobule – function unit of breast for milk production
- Male breast – no lobule / TDLU ; Female breast – presence of TDLU
- Flow of secretion/production of the milk:
 - In a TDLU u can have 10-100 Acini > Lobule > Lobe > Lactiferous duct > Lactiferous sinus
> Nipple

2 Types of Epithelial Cells (lining the lobules and ducts)

- Luminal cells
o Mostly in the lumen
o Can have 2 or 3 layers
o Cuboidal/columnar in shape
o Produce milk
o Precursors to CA

- Myoepithelial cells
o Seen in the periphery
o Myo means muscles, serve for contraction
o Located in the outermost, they are incomplete and spindled in shape.
o They help in contraction to expel milk
o Produce and maintain basement membrane?
o Presence indicates benign condition; absence denotes irregularities esp. in
plastic lesions

2 Types of Stroma -> where acini/acinus are embedded

- Depends on age, menstrual status, pregnancy history and lactation.

- Interlobular

o in between one lobule to another lobule it is called interlobular stroma.

o Made up of dense fibroconnective + adipose tissue
o Dictates the size, shape, motility of the breast

- Intralobular
o Stroma within the lobules are called intralobular stroma.
o Made up of loose CT AND SOMETIMES MYXOMATOUS
o Hormonally responsive
o Presence of lymphocytes signifies that there is immune component of the
breast
o Main function: function and support of TLDU

CONGENITAL BREAST LESIONS

#1 – Supernumerary nipples / Polythelia

#2 – Amastia

#3 – Inverted nipple/thelia

#4 – Polymastia – accessory breast

#5 – MEGAMASTIA / GIGANTOMASTIA

INFLAMMATORY BREAST LESIONS

#1 – Acute Suppurative Mastitis – numerous polymorphonuclear cells, pus cells

#2 – Tuberculous Mastitis – granuloma, multinucleated giant cells, lymphocytes and epitheloid cells

#3 – Mondor’s disease – phlebitis of the breast – inflamed veins affecting the breasts

#4 – Zuska Disease – recurrent sub areolar abscesses

- Painful erythematous subareolar masses

- 90% are smokers (vit A deficiency)
- Seen both in males and females
- Not associated with lactation

OTHER LESIONS

#1 – Duct Ectasia – cyst-like lesions that seems like it has milk inside, duct enlarged then cyst-like
structure, secretions

#2 – Enzymatic Fat Necrosis – trauma to the breast will produce mast-like lesions in the breast with a hx.
Of trauma;